I'm an addict in recovery. In the past alcohol and then switched to opiates (sadly all to common story of getting pills from MD unnecessarily). I haven't faced many consequences and have been still successful in tech. still not 'out' about opiates to work or friends, just my peers in recovery.
I have found the underlying hypothesis of this - group support - has been a really big help for me. I found a group for those in recovery that participate in sports (the Phoenix) which has a double punch of great community and also physical activity which is super beneficial.
For me, I think this has been the second biggest contributor to success.
But my #1 - with opiates in particular - is medicine replacement therapy. I tried so many times to get off myself. I finally got on buprenorphine which has been a lifesaver and successful to date on first try [one year!]. There are also some drugs now for alcoholism but unfortunately stimulants seem to not have great options.
It seems a shockingly low amount of rehabs use replacement therapy [1] [2] or even know about it (or even as a short term withdrawal taper tool). There are also a scary amount of overdoses from relapse post rehab.
I think the science is pretty convincing - there are studies showing even if relapse after maintenance therapy the period of abstinence before relapse is longer [3] - and also just seems like MUCH higher success rate [4].
BUT this is still an opiate! My doctor has patients who have been on for years. A lot struggle to get off. I personally don't have a problem with very long term use - personally I see parallels with SSRIs/SNRIs where many users report problems getting off and withdrawal, but obviously who would say you should get off something like prozac - a mind altering drug that has clear benefit?
The most FU part of this for me - it still takes a special license to dispense buprenorphine replacement therapy, patient numbers are capped per MD, and there is a ton of stigma all around even at pharmacies who dont blink twice doling out opiates. Pisses me off when looking at how most MDs can dole out opiates with far less training/license requirements. also pharma definitely profits - though there are now generics. i've found at least for the strips it's basically the same price. The pills without naloxone are cheaper - but for addicts struggling that gets rid of the back stop and overdose preventer.
Plus having only a few Drs in many states (or none) that charge cash or medicare only makes it in-accesible for many of the downest and out addicts. It should be free (or covered by the worst pharma co s) and FAR more MDs should be able to write script.
[1] https://www.samhsa.gov/data/sites/default/files/N-SSATS%20Rp...
[2] https://www.rehabs.com/pro-talk/opioid-addiction-treatment-w...